COVID-19 Admission Rates and Changes in US Hospital Inpatient and Intensive Care Unit Occupancy

Key Points Question Were COVID-19 admission rates associated with inpatient and intensive care unit (ICU) occupancy rates in 2020? Findings In this cross-sectional study of 3960 US hospitals in 45 US states, weekly rates of COVID-19 admissions were less than 4 per 100 beds for 64% of hospital-weeks and at least 10 per 100 beds in 16% of hospital-weeks. During weeks with low COVID-19 admissions (<1), inpatient occupancy decreased by 13%; during weeks with high COVID-19 admissions (≥15), inpatient occupancy increased by 8% and ICU occupancy increased by 68%. Meaning COVID-19 admission rates were associated with substantial changes in occupancy, with ICUs especially strained during surges.


Hispanic
Non-Hispanic Black

eTable 8 .
Changes in Occupancy by Service Line During 2020, Full Regression Results a

eFigure 1 .
Distribution of Duration of Periods With High COVID-19 Admissions a,b a Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for 45 US states.b A period of high COVID-19 is defined as a set of consecutive weeks with high COVID-19 admissions for a given hospital.Duration is calculated starting from the first week with high COVID-19 in each period.Each hospital may contribute more than one period with high COVID-19.Weighted by number of admissions in 2019 for each hospital.Time frame: 2020, weeks 1-48.More than 10 weeks mapped to 10.
Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient a

eTable 3 .
Percent Distribution of Hospital-Weeks by COVID-19 Admission Rate per 100 Inpatient Beds and State, 2020 Weeks 11 to 48 a,b All distributions calculated using hospital level weights equal to the number of admissions in 2019.c Distribution in Florida suppressed (sup.) because of disclosure restrictions.COVID denotes weekly COVID-19 admissions per 100 beds.
b c COVID denotes weekly COVID-19 admissions per 100 beds.Panel C. All hospitals, weighted by admissions by race/ethnicity a,b,d a Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for 45 US states.b Regressions compared outcomes for each hospital-week of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.Means and regressions were weighted by the number of admissions for each hospital in 2019.c Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for 45 US states.b Regressions compared outcomes for each hospital-week of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.Means and regressions were weighted by the number of admissions for each hospital in 2019.c COVID denotes weekly COVID-19 admissions per 100 beds.d States without ICU data and states missing more than 5% of data on race/ethnicity excluded (Louisiana, Montana, North Dakota, Nebraska, and West Virginia).Changes in Inpatient Occupancy During Low and High COVID-19 Admissions, Sample of 33 States With Data on Intensive Care Unit Admissions a,b,c eTable 5.
Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for 33 US states.b Changes compared outcomes for each hospital-week in weeks 11-48 of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.c Means and regressions were weighted by the number of admissions for each hospital in 2019.Regressions weighted by number of admissions in 2019 by race/ethnicity.States with more than 5% of data on race/ethnicity excluded (Louisiana, Montana, North Dakota, Nebraska, and West Virginia).g Other includes non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, or multiple races or ethnicities.Regressions compared outcomes for each hospital-week of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.Means and regressions were weighted by the number of admissions for each hospital in 2019.c COVID denotes weekly COVID-19 admissions per 100 beds.Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for 33 US states.b Regressions compared outcomes for each hospital-week of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.Means and regressions were weighted by the number of admissions for each hospital in 2019.c COVID denotes weekly COVID-19 admissions per 100 beds.
a d Low COVID-19 admission rate corresponds to less than 1 weekly COVID-19 admission per 100 beds.e High COVID-19 admission rate corresponds to 15 or more weekly COVID-19 admissions per 100 beds.fb Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for 33 US states.b Regressions compared outcomes for each hospital-week of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.Means and regressions were weighted by the number of admissions for each hospital in 2019.c COVID denotes weekly COVID-19 admissions per 100 beds.d States without ICU data and states missing more than 5% of data on race/ethnicity excluded (Louisiana, Montana, North Dakota, Nebraska, and West Virginia).e Other includes non-Hispanic American Indian or Alaska Native, Asian or Pacific Islander, or multiple races or ethnicities.Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020).b Regressions compared outcomes for each hospital-week of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.Means and regressions were weighted by the number of admissions for each hospital in 2019.c Inpatient occupancy measured per 100 beds and estimated using data from 45 states.d ICU occupancy measured per 100 beds and estimated using data from 33 states.e Low COVID-19 admission rate corresponds to less than 1 weekly COVID-19 admission per 100 beds.f High COVID-19 admission rate corresponds to 15 or more weekly COVID-19 admissions per 100 beds. a Data are from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases (2019-2020) for 45 US states.b Regressions compared outcomes for each hospital-week of 2020 to the corresponding hospital-week in 2019, i.e., regression models included hospital-week fixed effects.Means and regressions were weighted by the number of admissions for each hospital in 2019.c COVID denotes weekly COVID-19 admissions per 100 beds.d M/SUD denotes mental health and substance use disorders.
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